Key Points:

Positive Aspects of DOACs: DOACs are acknowledged for their convenience, efficacy, and safety in conditions like atrial fibrillation (AF) and venous thromboembolism (VTE). The review supports their use in stroke prevention, AF, recent acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI), valve disease (with exceptions), VTE management, cancer-associated thrombosis, stable atherosclerotic cardiovascular disease, and peripheral-artery revascularization.

Conditions Where DOACs Are Not Recommended: DOACs are cautioned against in specific medical settings, including mechanical heart valves, rheumatic AF, transcatheter aortic valve implantation (TAVI), embolic stroke of undetermined cause (ESUS), left ventricular assist devices, heart failure with reduced LV systolic function without AF, and thrombotic antiphospholipid syndrome (APS).

Areas of Uncertainty and Need for Research: The paper identifies areas where the benefit of DOACs remains uncertain due to a lack of dedicated trials or inconclusive results. These include left ventricular thrombus, catheter-associated deep vein thrombosis (DVT), cerebral venous sinus thrombosis, and splanchnic vein thrombosis. The need for further research, especially in catheter-induced DVT, is emphasized.

Reference: J Am Coll Cardiol. 2024 Jan, 83 (3) 444–465